Hepatitis C Translating Initiatives for Depression Into Effective Solutions
| Status: | Completed |
|---|---|
| Conditions: | Depression, Hepatitis |
| Therapuetic Areas: | Immunology / Infectious Diseases, Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 99 |
| Updated: | 4/21/2016 |
| Start Date: | February 2012 |
| End Date: | November 2015 |
Hepatitis C Translating Initiatives for Depression Into Solutions
Chronic infection with hepatitis C (CHC) is a common and expensive condition, and it
disproportionately affects Veterans. Treatment with antiviral therapy reduces liver disease
progression and improves health related quality of life. However, ~70% of Veterans with CHC
are considered ineligible for antiviral treatment. Most of these patients are excluded due
to the presence of co-existing depression and substance use. The proposed project will adapt
and adopt an evidence-based collaborative depression care model in CHC clinics. By removing
the leading contraindication for antiviral treatment, this project will potentially yield
benefits that go far beyond the obvious quality of life benefit from antidepressant therapy
itself.
disproportionately affects Veterans. Treatment with antiviral therapy reduces liver disease
progression and improves health related quality of life. However, ~70% of Veterans with CHC
are considered ineligible for antiviral treatment. Most of these patients are excluded due
to the presence of co-existing depression and substance use. The proposed project will adapt
and adopt an evidence-based collaborative depression care model in CHC clinics. By removing
the leading contraindication for antiviral treatment, this project will potentially yield
benefits that go far beyond the obvious quality of life benefit from antidepressant therapy
itself.
Project Background and Rationale: Depression is highly prevalent, yet under-diagnosed and
under-treated in CHC. Treatment models that increase collaborative management of depression
by mental health and physical health clinicians can improve quality and outcomes, and
collaborative care models have been identified as the best-practice for depression in VA
primary care settings. However, the antiviral treatment for CHC patients may not benefit
from the existing primary care-mental health integration because the antiviral treatment is
time-limited and conducted in specialty clinics. Although there is little evidence
evaluating the effects of collaborative depression care in specialty settings, QUERI
HIV-hepatitis initiated one of the first such efforts that effectively implemented
collaborative depression care in HIV clinics. Built on this experience, an intensive yet
focused collaborative care model in CHC clinics may be effective in improving not only
depression but also CHC care. This proposed study, "Hepatitis-Translating Initiatives for
Depression into Effective Solutions (HEP-TIDES)" will target this issue.
Project Objectives: The proposal has three overarching primary aims and one exploratory aim.
The primary aims are (1) adapt and adopt the collaborative care model for improving
depression care in specialty CHC care settings, (2) compare the effectiveness of HEP-TIDES
to usual care in improving CHC care, and (3) compare the effectiveness of HEP-TIDES to usual
care in improving depression care. The exploratory aim is to evaluate the cost-effectiveness
of HEP-TIDES versus usual care.
Project Methods: HEP-TIDES is a multi-site, multi-method implementation project. HEP-TIDES
will use evidence-based quality improvement (EBQI) methods to adapt and implement depression
screening and the collaborative care model for depression in the CHC clinics at 4 disparate
VA facilities (aim 1). HEP-TIDES will involve CHC and mental health providers working with
an off-site depression care team comprised of a depression care nurse manager, pharmacist,
and a psychiatrist. The purpose of the team will be to support CHC and mental health
clinicians in delivering evidence-based stepped-care depression treatment. The adapted model
will also take into account the substance use disorders among CHC patients. HEP-TIDES
implementation will be assessed using a formative evaluation of the implementation process
and a summative evaluation of a randomized controlled implementation trial of collaborative
depression care in 242 patients (aims 2 and 3).
under-treated in CHC. Treatment models that increase collaborative management of depression
by mental health and physical health clinicians can improve quality and outcomes, and
collaborative care models have been identified as the best-practice for depression in VA
primary care settings. However, the antiviral treatment for CHC patients may not benefit
from the existing primary care-mental health integration because the antiviral treatment is
time-limited and conducted in specialty clinics. Although there is little evidence
evaluating the effects of collaborative depression care in specialty settings, QUERI
HIV-hepatitis initiated one of the first such efforts that effectively implemented
collaborative depression care in HIV clinics. Built on this experience, an intensive yet
focused collaborative care model in CHC clinics may be effective in improving not only
depression but also CHC care. This proposed study, "Hepatitis-Translating Initiatives for
Depression into Effective Solutions (HEP-TIDES)" will target this issue.
Project Objectives: The proposal has three overarching primary aims and one exploratory aim.
The primary aims are (1) adapt and adopt the collaborative care model for improving
depression care in specialty CHC care settings, (2) compare the effectiveness of HEP-TIDES
to usual care in improving CHC care, and (3) compare the effectiveness of HEP-TIDES to usual
care in improving depression care. The exploratory aim is to evaluate the cost-effectiveness
of HEP-TIDES versus usual care.
Project Methods: HEP-TIDES is a multi-site, multi-method implementation project. HEP-TIDES
will use evidence-based quality improvement (EBQI) methods to adapt and implement depression
screening and the collaborative care model for depression in the CHC clinics at 4 disparate
VA facilities (aim 1). HEP-TIDES will involve CHC and mental health providers working with
an off-site depression care team comprised of a depression care nurse manager, pharmacist,
and a psychiatrist. The purpose of the team will be to support CHC and mental health
clinicians in delivering evidence-based stepped-care depression treatment. The adapted model
will also take into account the substance use disorders among CHC patients. HEP-TIDES
implementation will be assessed using a formative evaluation of the implementation process
and a summative evaluation of a randomized controlled implementation trial of collaborative
depression care in 242 patients (aims 2 and 3).
Inclusion Criteria:
- confirmed untreated infection (positive HCV RNA test)
- current PHQ-9 score of 10 or more
- current treatment in the CHC clinic
Exclusion Criteria:
- non-Veterans
- patients who do not have access to a telephone
- patients with current suicidal ideation
- patients with significant cognitive impairment as indicated by a score > 10 on the
Blessed Orientation Memory and Concentration Test
- patients with a chart diagnosis of schizophrenia
- patients with a chart diagnosis of bipolar disorder who have been hospitalized for a
mental health condition within the last 12 months
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4
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